Provider Demographics
NPI:1295856011
Name:SMITH, DEKEN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:DEKEN
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S SAN TOMAS AQUINO RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4449
Mailing Address - Country:US
Mailing Address - Phone:408-374-4500
Mailing Address - Fax:408-374-3034
Practice Address - Street 1:915 S SAN TOMAS AQUINO RD
Practice Address - Street 2:STE. 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-4449
Practice Address - Country:US
Practice Address - Phone:408-374-4500
Practice Address - Fax:408-374-3034
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0259320Medicare PIN